Three things I wish I'd known: Looking back at residency life

In a recent editorial, Suzanne Koven, M.D - primary care internal medicine physician at Massachusetts General Hospital in Boston - shared a letter that she wrote to her younger self.

Having witnessed new interns go through an exercise of writing a self-addressed letter that was going to be sent to them 6 months later, she described how she was "filled with longing" and wanted to share with these interns and her younger self what she wished she had known.

Dr. Koven explained in her heartfelt letter that she "wasted much time and energy in [her] career looking for reassurance that [she] was not a fraud," telling her younger self that one of the obstacles that she will need to overcome are the feelings of "impostor syndrome."

She added, "You see, I've been haunted every step of my career by the fear that I am a fraud."

Dr. Koven explained how this struggle has changed her perception of medicine over the years. "In the first few years in practice, I was sure that being a good doctor meant curing people."

But today, she has come to the realization that some things are beyond her control. "How I wish I could spare you years of self-flagellation and transport you directly to this state of humility!"

Her final message to her younger self is, "My dear young colleague, you are not a fraud. You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better."

Armed with the wisdom of hindsight, we probably all have things that we want to spare our younger selves from. So what do today's physicians wish they had known about their training?

Medical News Today spoke to Mr. Onur Gilleard, who recently finished his plastic surgery residency and is now a consultant at the Royal London Hospital in the United Kingdom.

Reflecting on his 6 years of residency training, here is what Mr. Gilleard wishes he had known.

1. The journey is a marathon, not a sprint

"Although this may seem like a banal cliché, I can't think of anything that better sums up surgical training," Mr. Gilleard said.

As a first-year resident, Mr. Gilleard had a steep learning curve ahead of him.

"It felt almost impossible that I would ever be able to perform the complex operations, such as reconstructing a breast after a mastectomy or a leg after severe trauma, that I saw the consultants undertaking," he said. At the time, his skill level was limited to only simple surgical tasks, such as cutting out skin lesions or suturing simple wounds.

But as his training progressed, Mr. Gilleard began to assist with the more difficult reconstructive cases.

Yet while being able to perform specific tasks within a case, such as suturing and cutting, the thought of having the knowledge and skill to be able to do complex operations independently felt extremely daunting, if not impossible.

Listening to his colleagues boast about their achievements didn't help. He said, "I just felt like I wasn't progressing quickly enough. Now I realize that this probably wasn't true."

Weeks and months would pass, and Mr. Gilleard would feel that he had not learned anything new.

"Now that [I] have finished training," he explained, "I can see that while I had these feelings of stagnation, I was, in fact, learning valuable lessons. At the time, however, all I was focused on was making big strides in my surgical skills."

"But in fact, the subtleties of patient management and being able to do the simple things were skills I was gradually acquiring and are just as important. It feels as though if I'd appreciated this I could have saved myself a great deal of stress and anxiety."

Mr. Onur Gilleard

2. You can't always please everyone

Coping with mistakes is a common challenge for residents. But according to Mr. Gilleard, this is difficult for surgeons because they are competitive by nature; they want to succeed and impress their teachers.

"But now that I am a consultant, I think that sometimes I took too much to heart what my trainers at the time would say," Mr. Gilleard explained.

He also realizes that while learning a craft such as surgery, trainees can be in a vulnerable position. Complicated procedures that require the integration of anatomical knowledge, spatial awareness, and dexterity, which consultants have been doing forever, are all new to residents.

"I still remember comments like, 'What are you doing?', 'Why on earth are you doing that?', or 'Why don't you know this?' really affecting my confidence."

Too often he would compare his skills to those of the consultants. "However this was a ridiculous thing to do as these people [had performed] the same operation over 1,000 times, while it was my second attempt for example," he explained.

Or maybe that consultant, who had been so aggressive, was just having a bad day - which isn't an excuse, just a reality. "It doesn't make it right but it will happen and the important thing is that if it does, think about things objectively without taking them too personally."

3. Find out what is important to you

From the beginning, Mr. Gilleard realized that surgical residency was going to be a physically and emotionally draining journey.

He saw his friends making big sacrifices when it came to family and friends. "Often," he said, "my colleagues lived far away from their families, and the stress created by residency created problems in the relationships."

So Mr. Gilleard made the decision not to marry or have children, and to focus on his own well-being instead.

"I concentrated on work, ensuring that I got enough sleep and exercise. Supporting a family during residency was something I never thought I could do." Mr. Gilleard also made the decision to live close to the different hospitals he rotated through for his training, which he said made his life a lot easier.

This is one area in which Mr. Gilleard feels that he did things right - at least for him.

Reflecting on residency

Now that Mr. Gilleard is a fully fledged consultant, what are his final words when he looks back on his residency training?

"The journey is long. Looking after yourself physically and mentally are crucial if you wish to succeed," he told MNT. "This may mean making sacrifices in certain areas of your life."

"I do feel, however, the rewarding feeling of achievement that comes when you complete training makes it worthwhile. The ability to use the skills you have mastered to make a tangible positive difference in people's lives every day is something I believe only a relatively few people get to experience in their profession."

Mr. Onur Gilleard